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Where there's smoke ...

. . . there's likely a neighborhood hit by lung cancer. South Boston leads the pack, but it's fighting back.

Every year during Mike O'Malley's annual physical, as he was poked and prodded by his doctor, the two men would joust over O'Malley's pack-a-day smoking habit.

"Your father died of lung cancer," the doctor would say.

"You have to die of something," O'Malley would retort.

But this year, the doctor found something alarming in O'Malley's lungs: the beginnings of emphysema. And so 13 days ago, O'Malley, 61, threw out his cigarettes and filled his pockets with lollipops, licorice, and gum. He hasn't smoked since.

O'Malley, a lifelong South Boston resident who began smoking more than 40 years ago, hopes to avoid becoming one of his neighborhood's grimmest statistics: a second- or third-generation lung cancer victim. The people who live in the 3 square miles of South Boston are twice as likely to die of lung cancer, on average, than other residents of the city. The neighborhood's lung cancer death rate dwarfs even those of Charlestown and Hyde Park, the next deadliest neighborhoods for lung cancer, according to the Boston Public Health Commission.

No one knows precisely why lung cancer has struck with such vengeance in South Boston -- lung cancer killed Southie residents at the rate of 113 out of every 100,000 per year, compared with 58 per 100,000 citywide, between 2002 and 2004 -- although current smoking rates are also about 50 percent higher than the city average. Researchers say smoking causes between 80 and 90 percent of all lung cancer.

The high rates of lung cancer deaths and smoking have made South Boston a test case for the effectiveness of an intensive counseling program designed to help people quit. Daniel R. Brooks, an assistant professor at the Boston University School of Public Health, spent three years studying whether residents of the West Broadway Housing Development -- that's the D Street project -- would participate in a community program to stop smoking. In the pilot project, which ended in February, trained "tobacco treatment specialists," fluent in both English and Spanish, held individual and group counseling sessions; nicotine patches and other types of treatment were free to participants.

"Instead of having people go to some program," Brooks said, "we brought the program to the development."

Among the 49 smokers who participated in the project, 33 tried to quit. Seventeen of those smokers relapsed, but 16 reported they were still not smoking at the end of the project. Brooks is reluctant to draw conclusions from those figures, since the pool of smokers was relatively small and the project was designed to study whether residents would participate -- not whether they would quit. The study also relied on participants to tell researchers whether they had stopped smoking, rather than testing them to determine whether they actually had. And not all the quitters were followed for six months, the standard length of time to determine a smoker has really kicked the habit.

Still, there is reason to be optimistic: No more than 10 percent of people who try to quit smoking alone succeed. At D Street, 33 percent had quit.

Although the study ended, the work the researchers began in South Boston is continuing. Laurie Duro is a smoking-cessation counselor for the West Broadway Task Force who was part of the Brooks study and continues to coach residents to kick the habit. She meets individually with smokers in the development, once a week for as many weeks as they desire, to encourage them to stop.

"The residents I work with have so many other stresses in their lives," Duro said. "They use smoking as a way to cope. When stressors come up with money or the kids, it's always what they go back to."

Decades ago, there was little difference in the education levels of smokers, Brooks said. But now, the more education people have, the less likely they are to smoke.

One reason for the disparity is that better-off smokers are more likely to quit, according to data from the federal Centers for Disease Control and Prevention. People with college degrees are more likely to quit than those with less education, Brooks said. And smokers above the poverty level are more likely to stop than those below the poverty level.

Brooks says lower-income smokers are less able to afford help quitting smoking and more likely to have other stresses and problems that making quitting harder. And their peers are more likely to smoke, meaning they may have less social support to quit.

"The large disparity now is by socioeconomic status," Brooks said. "South Boston has been a historically working-class neighborhood."

Isabel Alicea had smoked for more than 30 years before she quit more than two years ago with Duro's help. Alicea, 46, had been a two-pack-a-day smoker who started smoking cigars when she was 12. She'd tried to quit before, even trying hypnosis, but had always relapsed. The difference this time, she said, was Duro's counseling.

"You need to talk to people," Alicea said.

She was so taken with the program that she trained to become a counselor herself, working with her neighbors to help them stop smoking. "When I was smoking, I never noticed people smoking," she said. "But when I quit, it was everywhere."

On Mondays, when a pulmonologist makes his weekly visit, some patients in the waiting room of the South Boston Community Health Center arrive dragging along oxygen canisters. Taryn McGoff, the center's nursing case manager, sees patients with lung cancer who continue to smoke. McGoff has helped create a stop-smoking program, with counselors like those at D Street, at the health center.

MassHealth, the state's Medicaid program, has recently begun paying for smokers to see counselors to help them stop smoking. The program has also begun covering the cost of the nicotine patch and other treatments that help wean people off cigarettes.

McGoff despairs when she sees young people smoking. "I wish they could see it on our end," she said, "when it doesn't look so sexy anymore and people are really just trying to get a breath, when people are walking around with their oxygen canisters."

Although smoking causes most cases of lung cancer, some South Boston residents also blame pollution, including that generated by the former Edison power plant at L and East First streets, now run by Exelon Corp., for their high rates of lung disease.

"I think there have also been concerns as a urban neighborhood with a lot of industry and traffic and sources of air pollution, there has also been concerns among residents that that has been a cause," Brooks said. "It's hard to tease those things apart. It's possible they both are, in fact, contributors."

O'Malley began smoking when he was about 20. He tried to quit several times, but always went back. He came from a family of smokers: His mother, 86, quit seven years ago; his brother quit earlier this year. He hopes he too can kick the habit.

"I'm listening to the doctor," O'Malley said.

Kathleen Burge can be reached at kburge@globe.com

Send us your smoke signal
Smokers -- or quitters -- City Weekly wants to hear from you. Tell us why you do it, despite all the evidence pointing to a smoking-lung cancer connection. Or tell us how you managed to kick the habit. And why do you think some neighborhoods have much higher rates of lung cancer than others? Send your response to City Weekly at ciweek@globe.com. Please include your name, a daytime phone number (for verification only), and your neighborhood, city, or town. Responses may be edited for length and grammar.

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